CORR Insights®: Is the Width of a Surgical Margin Associated with the Outcome of Disease in Patients with Peripheral Chondrosarcoma of the Pelvis? A Multicenter Study.

Abstract

Chondrosarcoma generally is resistant to radiotherapy and chemotherapy. Because of this, surgeons usually treat highergrade chondrosarcoma malignancies with wide surgical excision [2]. Achieving this in the pelvis calls for a good understanding of local anatomy, the tumor margin, and the tumor’s aggressiveness. A more-aggressive tumor with longer pseudopodia, more distant tumor satellites, and/or wider reactive zone warrants a wider resection margin. The chondrosarcoma tumor grading system divides the chondrosarcoma into three grades (I, II, III) based on the degree of cellularity, nuclear pleomorphism, necrosis and chondroid, or myxoid matrix. The higher the grade, the more aggressive the lesion. Unfortunately, tumor grading of cartilaginous lesions, even among experienced musculoskeletal pathologists and radiologists, is not reliable [5]. In addition, although the histology report categorizes these tumors into three distinct grades, the reality is that chondrosarcoma probably is better considered as a continuum of disease; even within tumors of the same grade, aggressiveness may vary widely. Making matters more complex, the grade on a pre-operative biopsy may also be misleading [10] as it and may not reflect the true histological grade of the tumor. In the current study, Tsuda and his colleagues [8] confirmed that there was a high percentage of underreporting of the histologic tumor grade. This can cause serious harm, since a surgeon may tolerate a narrower margin in a lower-grade tumor, while doing so in a high-grade malignancy could result in an unacceptable risk of local recurrence or worse. But in better news, this study also found that patients treated with a 1 mm surgical margin of the final resection specimen experienced no local recurrence, metastasis, or disease-related death regardless of chondrosarcoma tumor grade [8]. Based on this, a 1 mm surgical margin of the final resection specimen may be a reasonable goal in planning the resection plane preoperatively.